Provider Demographics
NPI:1699328419
Name:FARHADIAN, SHIRIN
Entity type:Individual
Prefix:
First Name:SHIRIN
Middle Name:
Last Name:FARHADIAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5028 BRIDGE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-5702
Mailing Address - Country:US
Mailing Address - Phone:314-630-5975
Mailing Address - Fax:
Practice Address - Street 1:14688 STATE HIGHWAY 121 STE 100
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035-4659
Practice Address - Country:US
Practice Address - Phone:972-677-3343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-21
Last Update Date:2020-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX354731223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics